网状脱细胞异体真皮联合自体刃厚皮片治疗婴幼儿巨型先天性黑色素细胞痣及远期效果观察  

Application of mesh acellular aliogeneic dermal matrix and split thickness autogenous skin to treat giant congenital melanocytic nevi in children

作　　者：王伊宁[1] 齐鸿燕[1] Wang Yining;Qi Hongyan(Department of Burns and Plastic and Reconstructive Surgery,Belting Children＇s Hospital Affiliated to Capital Medical University,Beijing 100045,China)

机构地区：[1]首都医科大学附属北京儿童医院烧伤整形科,北京100045

出　　处：《中华整形外科杂志》2018年第7期541-545,共5页Chinese Journal of Plastic Surgery

摘　　要：目的探讨应用网状脱细胞异体真皮基质与自体刃厚皮片复合移植，治疗婴幼儿巨型先天性黑色素细胞痣的临床方法及远期临床效果。方法2012年1月至2017年2月应用网状脱细胞异体真皮联合自体刃厚皮片修复55例婴幼儿体表巨大黑痣切除后的创面，年龄3个月至5岁10个月，平均1岁2个月，面积1％-25％总体表面积。头面部12例、躯干28例、四肢15例。分一期或多期手术切除，以网状脱细胞异体真皮基质覆盖创面，异体真皮上覆盖自体刃厚皮。术后2周打开包扎拆线，并行瘢痕康复治疗。随访10个月至3年，观察复合皮片术后3、6个月及l、2年的色泽、柔软度及瘢痕恢复情况，并对切除的巨痣组织及术后1年复合皮片进行病理学观察。结果2周拆线时复合皮片成活率为70％-100％。38例患儿获得2年以上随访。1年以上复合皮片可达到柔软弹性好，色泽与正常皮肤接近。结论网状脱细胞异体真皮基质与自体刃厚皮片复合移植早期治疗婴幼儿巨型先天性黑色素细胞痣，从外观到功能都能得到有效改善，同时避免了因采取自身全厚皮片遗留瘢痕的问题。关键技术点是保证前期植皮成活率。Objective To explore the methods and the long-term outcome ot composite skin graft with mesh acellular allogeneic dermal matrix （ allo-ADM ） and split thickness autogenous skin giant congenital melanoeytic nevi in infants. Methods From January 2012 to February 2017 our department applied acellular allogeneic dermis matrix （ allo-ADM ） with split thickness autogenous skin to treat 55 Giant congenital melanocytic nevi in infants and children aged 3 months to 5 years and 10 months, an average age was 1 years and 2 months, the area of 1% -25% TBSA. There were 12 cases of head and face, 28 cases of trunk and 15 cases of limbs. In operation, giant congenital melanocytic nevi was totally or partially resected, and using allo-ADM and split thickness autogenous skin graft to cover the wounds. Pressured gauze was removed 2 weeks after surgery, and at the same time the cicatricial rehabilitation was performed. The follow-up point was at 3 months,6 months, 1 year, 2 years, to observe composite skin＇ color, softness, and pathological examination of giant nevus and composite skin after 1 years were performed. Results 2 weeks after transplantation tile composite skin survival rate in 70% - 100% ; 38 eases were followed up for more than 2 years. For patients, over 1 years postoperatively, the composite skin presented soft and flexible, and the color were closed to the normal skin. Conclusions Acellular allogeneic dermis matrix with split-thickness autogenous skin to composite transplantation can effectively improve the appearance and function of giant congenital melanocytie nevi in infants and children, and avoid the scar formation due to the adoption of full thickness skin. The key is to ensure the early survival rate of composite skin graft.

关 键 词：黑色素细胞痣 脱细胞异体真皮基质 幼儿 

分 类 号：R758.51[医药卫生—皮肤病学与性病学]